Page 889 - Cardiac Nursing

9/2
9/0
8:3
009
0
75.
1-8
qxd
75.
6 A
65
65
ara
Apt
e 8
P
M
g
P
L L LWB
LWBK340-c38_38_p861-875.qxd 09/09/2009 08:36 AM Page 865 Aptara
p86
LWB K34 0-c 38_ p86 1-8 75. qxd 0 9/0 9/2 009 0 0 8:3 6 A M P a a g e 8 65 Apt ara
0-c
38_
K34
K34
C HAPTER 38 / Obesity: An Overview of Assessment and Treatment 865
1 Patient encounter
2 2
Hx of 25 BMI?
No
3 3
Yes
BMI
measured in past
2 years?
5 7
4 6 BMI 25 OR
• Measure weight, BMI 30 OR (BMI 25 to 29.9 OR
height, and waist waist circumference Yes Yes
circumference 88 cm (F) Assess risk factors waist circumference 88
• Calculate BMI cm (F) 102 cm (M))) ) )
102 cm (M) 8
AND 2 risk
Clinician and patient
factors) ) ) )
devise goals and
treatment strategy for
No No
weight loss and risk
12
12
14 4 12 2 factor control
14
Does
Yes Yes
Hx BMI 25? patient want to
Examination lose weight? 9
Progress
Yes
Treatment being made/goal
No No
achieved?
1
15 13
Brief reinforcement/ Advise to maintain No
educate on weight weight/address
management other risk factors
16 6 11 10 0
Periodic weight Maintenance counseling Assess reasons for
check • Dietary therapy failure to Iose weight
• Behavior therapy
• Physical activity
■ Figure 38-2 Treatment algorithm. This algorithm applies only to the assessment for overweight and obe-
sity and subsequent decisions based on that assessment. It does not include any initial overall assessment for
cardiovascular risk factors or diseases that are indicated. (Adapted from National Heart, Lung, and Blood In-
stitute, Obesity Education Initiative Expert Panel on the Identification Evaluation and Treatment of Over-
weight and Obesity. [1998]. Clinical guidelines on the identification, evaluation, and treatment of overweight and
obesity in adults: The evidence report. Bethesda, MD: National Institutes of Health.)

Eating and Physical Activity Patterns recipes or package labels if the food is unusual). Food frequency,
24-hour dietary recalls and activity questionnaires are another
A nutritional and physical activity assessment provides additional means of assessing past year food consumption or current level of
information that can be used in the treatment plan. This can be physical activity. 37–39 During the 24-hour dietary recall, the
done by having the patient complete a 3-day food and activity di- trained interviewer asks the patient to recall every food and drink
ary, which should include two work and one nonwork or leisure- that was consumed in the previous 24 hours. The interview may be
type days. When using a 3-day food and activity diary, the patient conducted either in-person or via the telephone, is usually unan-
needs to be instructed on completion of the diary and the details nounced, and typically takes 20 to 30 minutes to complete; this as-
to be included (e.g., exact amount of food eaten and inclusion of sessment tool may be more commonly used in a research setting. 37